Monthly Archives: April 2009

WILMINGTON ISLAND, GA (WTOC) – Students at St. Andrew’s School on Wilmington Island are doing something very special for their classmate who has battled childhood reflex neurovascular dystrophy or RND for five years.

It’s a very painful condition that requires lots of treatment and that’s why students are raising money for a disease their friend finally beat.

Students at St. Andrew’s organized a game of dodge ball to show support for their classmate Jay Helmreich who had RND.

“RND is a medical problem where the nerves foil to the extremities of the body, they are over active and firing a pain signal to the brain,” said Jay. “Every joint in my body expect my hips were in pain constant aching, and nothing to help it.”

After seeing 30 different doctors, Jay was treated at Children’s Hospital of Philadelphia.

“One of the few or only hospitals in America that treat RND. They do in patient therapy,” said Jay.

After six months of intensive therapy, Jay on longer has the condition, but friends like Jim Kingston still wanted to do something to raise awareness for RND and donate money to the Children’s Hospital of Philadelphia.

So they decided to hold a dodge ball tournament.

“We really wanted to do something to benefit the cause,” said Jim. “We really just wanted to help him out.”

And help others like Jay who suffer with the same condition.

“This school is great anything that anyone says about St. Andrew’s is true, this is a family oriented school,” said Beckie Helmreich, Jay’s mother.

Even if the kids get a little aggressive with dodge ball, they are playing for the right reasons and deserve the distinction of being WTOC Hometown Heroes.

New London woman continues eight-year fight for disability benefits

NEW LONDON — In the past eight years, Americans have seen everything from New York City attacked by terrorists to the first black president inaugurated.

New London resident Karen Malcom remembers September 2001 as the time she first filed for Social Security Disability Insurance and the beginning of 2009 as when she learned her case would be heard for a third time.

“Either I am or I am not (disabled). That’s what I want them to tell me,” Malcom said. “It’s got to stop. Laws are there for a purpose.”

She added: “How can it have taken seven years, and they still don’t know?”

Malcom realized she can’t fight alone, so she recently enlisted the help of 2nd District U.S. Rep. Dave Loebsack, D-Iowa.

In the couple weeks since she has talked with a case worker for the congressman, she’s already received word that he’s gone to bat for her.

She received a note in mid-March informing her a staff member has contacted the Social Security Administration Office of Disability and Adjudications Review in West Des Moines.

“Too often, cases like Karen Malcom’s get lost in the shuffle,” Loebsack said via e-mail. “We are doing everything we can to cut through the red tape and enable Ms. Malcom to receive her Social Security disability.”

In the time Malcom has been waiting for benefits, she has not only seen the world around her change, but she’s also seen her own daughters grow older — the younger was 4 when Malcom first filed and is now 12. Malcom has even become a grandmother.

“Most people do get denied there at those (first) two stages,” Malcom said. “Almost everyone has to be heard at least once.”

Malcom had no idea, though, that she’d have to be heard by three judges and be denied no fewer than a half-dozen times.

Even experts say Malcom’s experiences are unusual.

“That is atypical in my opinion,” said Ed Swierczek, a senior claims consultant from Allsup Inc., a Social Security disability services company. “However, it is not impossible, as she found out.”

Swierczek, who has 35 years experience in the field, said remands occur for various reasons — such as a judge making a vocational decision without consulting an expert or simply personal bias — but not often multiple times. Malcom’s case has been remanded twice.

“It may well be closer to 20 percent get remanded,” Swierczek said.

Worse for Malcom, Dan Allsup, communications director with the company, said age 50 is often when people start being considered seriously. Malcom is 46.

Supporting evidence

Malcom’s physical pain started when she finished her shift at a local factory one day in March of 1999. At the time, she was diagnosed with bilateral carpal tunnel syndrome.

“The swelling was so sudden and severe in my fingers that my hands went from a normal appearance to a club-like appearance, preceded with intense pain,” Malcom said.

After being denied a referral to see her company’s doctor, she sought her own in June 1999.

She under went surgery and returned to work 11 weeks later. Within two months, the symptoms reappeared, and by a year later the diagnosis was worse.

Malcom still had symptoms of carpal tunnel, but she also was diagnosed with moderate cubital tunnel syndrome in her left elbow.

“They were not telling me I would not get better,” Malcom said. “By the time, I knew it, two years went by.”

Malcom was finally unable to return to work in the summer of 2001.

Malcom started working at 15, when she took her first job at the local Dairy Queen. Since 22, she has worked in various factory jobs in the region.

“You don’t get these diagnoses without working hard,” Malcom said.

In September 2001, on the advice of a local attorney, she applied for Social Security Disability Insurance benefits.

Not only did her troubles increase from that point, but so too did her list of ailments. She’s been to three pain clinics and seen at least a dozen doctors.

The last diagnosis usually is caused by surgery and can be precipitated by cervical spondylosis.

Although CRPS, the complex regional pain syndrome, is not fully understood, the diagnosis became an SSDI qualifying disease in 2003.

“It is in the Social Security rulings,” Malcom said. “I’m going to make them justify their own words.”

According to the Mayo Clinic’s Web site, CRPS is an uncommon, chronic condition that usually affects women 40 to 60 years old in their arms or legs.

“The main symptom is the burning pain, and you just have to quit whatever you’re doing,” Malcom said.

Malcom was further diagnosed with anxiety and depression.

Doctors have told her she has improved somewhat with conservative treatment — which means limiting the amount she is active — and with medicine. She’s taking Oxycodone every six hours instead of the methadone she once was prescribed.

Her daughters refuse to let her take the latter medication due to the harsh side effects she suffered.

Judging denials

Convincing judges that her condition means she can’t hold down a full-time job, however, is a different matter.

“You can have all the medical evidence and a strong case, but if they don’t use it … you’re going nowhere,” Malcom said.

For one, neither administrative law judge has considered her CRPS.

Also, neither judge considered the finding of “no jobs” by vocational experts in ruling against Malcom.

“I would have a better chance of doing lifting than typing, or anything like that that is really repetitious,” Malcom said. “I was the fastest (on the job); I’d hate to be the slowest now.”

Experts have said on top of Malcom’s physical inabilities, she is unable to handle the mental stress.

Allsup representative Swierczek said another common reason for a remand is the judge fails to consider the full range of symptoms that would prevent a person from working.

Ultimately, the first judge denied Malcom because of her desire to do more than she does, rather than her ability to do so, and looked at just a few of Malcom’s many conditions.

Unfortunately, the wording in the law is such that even though a job is unavailable, it only means a person may — rather than should or will — qualify for benefits.

The second judge also threw a false allegation into Malcom’s record that would automatically make her ineligible for benefits. In granting the second remand, the ruling stated that not only was there no basis for the accusation but it was forbidden to be brought into the record at the third hearing.

The first judge finally denied her claim in October 2004, more than three years after she applied.

Allsup said the average wait time in Iowa is 571 days. The longest is 733 days — without counting cases like Malcom’s, which have been remanded.

Malcom’s first remand came in 2007, after she’d already re-filed her claims in May 2005. The second judge denied her claim in January 2008, and Malcom was granted a third hearing in February 2009.

Getting worse

While Malcom hasn’t given up hope, things are starting to look bleak.

Malcom had received some assistance from workers’ compensation for her carpal tunnel and as yet undiagnosed pain problems.

But eventually the bills pile up, and the money runs out.

After the first administrative law judge’s denial in October 2004, Malcom could no longer make ends meet for her and her daughters, Kala and Dakotah.

Her ex-husband and father of the younger Dakotah, Steve Malcom, offered to have them move in with him temporarily. Karen Malcom pays rent to Steve Malcom using the money he provides for child support.

“He’s been the only one that has tried to help us besides my parents,” Karen Malcom said.

She said it’s been hard to watch the one person who has kept the family from becoming homeless live the way he’s been forced to live during the last five years.

“They’re not just hurting me, they’re hurting the people around me that are able to help,” Karen Malcom said. “For five years, he has provided everything for the girls that I couldn’t.”

Through all this, in the back of Karen Malcom’s mind, is that the possibility remains that she will ultimately be denied.

Her Social Security nightmare is she’s going to be offered a deal, which will leave her with some money but not the full benefits she is owed going back to 2001.

“It is known that they do that,” she said.

Because she’s been working since she was 15, Malcom should be granted maximum benefits.

“If they’re not paying it now, what would make us think they’re going to want to pay it then?” Malcom said.

If she’s ultimately denied, she’ll be forced to go back to work — a hard enough task in itself — and she’ll have zero credits toward Social Security Disability benefits.

Moving forward

While Malcom waits for her third hearing — for which a date may not be set and could be as long as the others were — she keeps herself sane by spending time with her 3-year-old grandson Kaiden Holtkamp.

Kaiden suffered a traumatic brain injury after a car accident in February 2008. A social worker has helped Malcom file disability claims for her grandson, so she may have to go through the process again.

Kaiden’s claim already has been denied once by Disability Determination Services.

To keep busy, she spends time constantly revisiting her two binders of case information, still scouring for more details that may have been overlooked in her previous hearings.

She feels so strongly about being represented in the right way that she is considering representing herself to portray her passion.

Allsup spokesmen advise against it, suggesting an attorney or professional representative. Swierczek compared it to people going to H & R Block to get their taxes done rather than taking it on themselves.

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Article published March 29, 2009MOVING FORWARDRetired physician with a disability fights for the right to get around on a Segway

By RYAN E. SMITHBLADE STAFF WRITERDr. Patrick McNamara gets out of his silver minivan and hobbles a few steps, leaning heavily on a homemade wooden cane. There is pain in every awkward movement the 51-year-old makes — until he pops open the trunk and grins.

“In a moment, I will no longer be handicapped,” he declares.

The next thing you know, he’s zipping around the parking lot like Willy Wonka — he’s still holding the cane — using a Segway to run circles around an observer. He continues to show off inside a nearby supermarket, gliding around with ease, pushing a shopping cart, and exhibiting no trace of the nerve ailment that leaves him in severe pain most of the time.

“I’m not disabled when I’m on this,” says Dr. McNamara, who has complex regional pain syndrome and retired from internal medicine three years ago. “It’s such a completely rehumanizing experience.”

That’s what interests the Sylvania Township man most. Sometimes the solution is flashy and high-tech, like the Segway he uses to get around. At other times, it’s as old-school as the canes that he makes from scratch in his basement workshop.

It all began when Dr. McNamara injured his back while exercising and found that he had trouble walking even a short distance due to the extreme pain. He investigated all sorts of help: scooters, wheelchairs, hiking sticks, metal canes, but each had its own problem.

“The devices that you use to get around kind of mark you,” he says. Consider aluminum canes, for example. “They’re ugly, they’re cold, they’re uncomfortable,” he says. “They mark you as someone sick or disabled.”

Then he tried a Segway and everything changed.

When the two-wheeled device was unveiled in 2001, it was envisioned as a way to transform car-clogged cities, not as a tool for people with impaired mobility. But that hasn’t stopped Jerry Kerr, president of Disability Rights Advocates For Technology in St. Louis, from calling it “one of the greatest things ever designed for people with disabilities.” Mr. Kerr said there are thousands of people who have difficulty walking who use Segways, which move forward simply based on the user leaning in that direction.

Karen A. Whalen, owner of Segway of Ohio: Toledo, says people with disabilities make up about 30 percent of her sales. (Most of the rest come from police and security companies.)

“It really gives them back their lives,” she says. “They just get this huge smile.”

It’s a smile that’s seen often on Dr. McNamara’s face when he talks about how the invention revolutionized his life, allowing him to go to the store or join his family for his son’s baseball games. It also keeps him at eye-level, unlike a wheelchair, which he finds painful.

These days, Dr. McNamara doesn’t leave home without his Segway. He keeps it ready to go in the back of his van where, once it’s turned on, he can easily roll it down a pair of portable tracks.

While federal buildings under the jurisdiction of the U.S. General Services Administration allow Segway use by people with disabilities, not everyone else does, sometimes citing safety concerns. Nationally, the spotlight is on Walt Disney, which prohibits people from bringing personal Segways into its parks.

Locally, it became a kind of quest for Dr. McNamara to make the city more Segway-friendly for the disabled and to raise awareness. He said he hasn’t had any trouble at private businesses and worked with the Ability Center of Greater Toledo to gain access to the Metroparks of the Toledo Area.

Getting his Segway into One Government Center proved more difficult. In 2007, Dr. McNamara tried to use his Segway there and was not allowed to in an incident he called humiliating.

The Ohio Civil Rights Commission found probable cause that he was denied access to a place of public accommodation due to his disability in violation of state discrimination law.

“We essentially didn’t see that this was all that different from a motorized wheelchair,” says spokesman Brandi Martin.

In November, more than a year after the original incident, the Ohio Building Authority, which owns the building, put in effect a new policy regarding Segway use on the same day Dr. McNamara filed a federal lawsuit against it. He has since received a settlement from the OBA.

Dr. McNamara’s claim against the other defendant in the lawsuit, Reuben Management, which manages One Government Center, has not been resolved. Lisa L. Nagel, an attorney for Reuben Management, says it enforced existing policy and provided a wheelchair as a reasonable accommodation.

Nationally, access issues don’t seem to be widespread. A bigger roadblock is price. Segways start at more than $5,000 and are not covered by health insurance, putting them out of reach for many.

“The Segway was not designed as a mobility device and has not been approved by the FDA as a medical device so we are not allowed to market it as a medical device,” says Carol Valianti, a spokesman for Segway Inc.

Fortunately, Dr. McNamara has found lower-tech and less expensive ways to help humanize those with disabilities. After all, the Segway can help him in the grocery store but he still needs something to get him around the house. So he bought some tools a year ago and learned to make wooden canes from scratch.

“It kind of gives me a purpose in life,” he says. “I get to make something that’s not only comfortable and useful, but also beautiful.”

Working downstairs, a stack of wood nearby, he shaves the wood with purpose and molds a cane handle until it conforms perfectly to his hand. The result is something elegant and distinguished.

“I wanted something that was comfortable and attractive and doesn’t say, ‘sick person,’” he says.

Already Dr. McNamara has donated about a dozen of his creations to the Ability Center and more are in the works. The Ability Center plans to loan them out for a nominal fee.

“I can’t practice medicine any longer,” he says, “but I have found another way to be helpful to others.”

Received 8 January 2009; accepted 12 January 2009. published online 24 February 2009.

Summary

The mechanism of action of the stellate ganglion block (SGB) is still uncertain; however it has been used successfully in treatment of chronic regional pain syndrome (CRPS) for many years. Our new insights in to the mechanism of action of the stellate ganglion block were first reported in 2007 in our publication detailing the control of hot flashes with the use of stellate ganglion blockade. We have demonstrated very significant results in the treatment of hot flashes and our most recent application of this block has been for the treatment of posttraumatic stress disorder (PTSD).

Stellate ganglion has been demonstrated to have second and third order neurons connections with the central nervous system nuclei that modulate body temperature, neuropathic pain, the manifestations of PTSD, and many other areas.

We believe that the commonality between the CRPS, HF and PTSD is the trigger of increased nerve growth factor (NGF) leading to the increase in brain norepinephrine (NR), which in turn is affected by the SGB leading to a prolonged reduction of NGF and eventually a decrease in NR. This, in turn, leads to a reduction or elimination of many of the symptoms of CRPS, Hot flashes, and PTSD.

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£400,000 award for finger injury

Wednesday 1 April 2009

A mechanic who injured his index and middle fingers while repairing a police car, yesterday won £400,000 in damages from the Metropolitan police.

Alexander Darg had claimed £1m in compensation after cutting himself on a knife which was wedged down a driver’s seat.

The 39-year-old from Vigo, a village in north Kent, was hurt in 2002 at Limehouse police station in east London, where he was checking an airbag fault. His wedding ring had to be cut off after the incident and he required a number of stitches.

Two years later he gave up work after being diagnosed with a condition known as complex regional pain syndrome, saying that the injury prevented him from living a normal life.

Liability was admitted by the Metropolitan police, but it strongly disputed the extent of the injuries and the amount of damages claimed.

The high court was shown video footage which, according to lawyers for the force, showed that Darg had overstated his disabilities. The Met’s legal team also accused him of “spicing up” his disabilities and argued that he was due to be compensated only for superficial cuts which had healed afterwards.

Sir Robert Nelson, the judge, accepted that Darg’s disabilities had been exaggerated to an extent but ruled that the married father-of-two had never “falsely pretended to have symptoms which do not exist”.